Registration form for the Eager Free Public Library's STEAMpunks Club. STEAMpunks is a popular hands-on program offered on days off of school that incorporates science, technology, engineering, arts and math for kids in grades K-5.

You only need to sign up once during the 2017-2018 school year. You'll receive a reminder email with an RSVP request a few weeks before each STEAMpunks event. An RSVP each time is greatly appreciated!

Questions? Call the Eager Free Public Library at 608-882-2260.

This school year STEAMpunks will meet on the following Mondays: October 9, November 27, February 12, March 18, and April 16.

* Required

Child(ren) Name(s) *

Please record the first and last names of the child(ren) you are signing up to attend the STEAMpunks Club

Your answer

Parent/Legal Guardian Name *

Please record the first and last names of parents and legal guardians of the child(ren) you are signing up to attend the STEAMpunks Club

Your answer

Age(s) of Child(ren) *

Please record the age(s) of the child(ren) attending the STEAMpunks Club

Your answer

Phone Number *

Where can you or another parent/guardian be reached in case of emergency?

Your answer

Email Address *

To receive updates about the STEAMpunks Club, please fill in a working email address

Your answer

When the program ends, my child has permission to: *

Please make sure you and your child discuss the plan ahead of time!

Get picked up by a parent or other care provider

Walk home

Other:

Who has permission to pick up your child?

If anyone besides a parent/guardian is picking up your child, please record their first and last name. Please note: children will be asked to stay in the program room until their ride is here.

Your answer

Anything else we should know?

We will provide a light snack during the program. Please note any health or allergy concerns below.

Your answer

Photo/Video/Audio Release *

Can we take and use photographs of your child(ren) at STEAMpunks?

Yes - I hereby consent to the use of any photographs, video or audio clips of my child in news coverage or publicity for the Eager Free Public Library. This may include use in our newsletters, brochures, fliers, posters, and/or web pages.

No - I do not consent to the use of photographs, video or audio clips of my child(ren).

Will your child attend the activity day on Monday, October 9, 2017 from 1:00-3:00 p.m.? *